This post is part of our "Key Questions" series, which we developed to help you understand more about what questions a Headache Specialist should ask during the process of diagnosis and treatment. Click here to visit the Key Questions Series page to see all the posts in the series and learn more!
Your medical professional should address the following questions and concerns regarding any previous treatment you have received for your headaches:
When should you take it? Do you have enough for every headache day of the month? Does it work each and every time? Are you completely pain free within 2 hours? What about the other symptoms? Are they gone within two hours? The nausea, photophobia and phonophobia? What about your ability to function? Do you have to go to bed? Do you have to leave work or miss your child's soccer game? Do you get to pain 0/10 in two hours? Does it take one medication to relieve your headache attack or a combination? Which medication works best? What does not work? Do you take your antinausea medication with your headache medication?
ER VISITS DUE TO HEADACHE:
Have you ever had a headache bad enough to go seek treatment at an ER or an urgent care center? How often do you seek medication treatment in a clinic or ER for headaches that do not respond to your current treatment plan? What does the ER/clinic usually do for you?
Have you ever had a scan of your brain? Was it after you started having headaches? What type of scan was it? A CT? An MRI? Was the MRI with contrast? Has there been a change in your headache since you had your brain scan? Has the frequency or severity of your headaches dramatically increased? Has there been a dramatic change in the pattern or character of your headaches over time?
Note: The vast majority of migraine sufferers do not require neuroimaging. Click on the links below to reference the guidelines from the American Headache Society and the American College of Radiology. CT should never be performed for headache disorders when MRI is available, except in the ER setting. MRI with and without contrast is the recommended scan to rule out secondary (or dangerous) causes of headaches. Patients with migraine, cluster and other primary headache disorders are expected to have NORMAL brain scans. Occasionally a scan of a migraineur will report scattered, diffuse white matter lesions (or spots). These are not the same white matter lesions as seen in Multiple Sclerosis. These are neither diagnostic of migraine nor exclusionary. These findings do not guide assessment, diagnosis or treatment. Sometimes scans reveal incidental pathology that may be either insignificant or serious. The yield of positive pathological serious problems when scanning a patient's brain without any significant red flags on the exam or history is very minimal. Therefore, routine brain scanning is not recommended.
When was the last set of labs drawn? Wellness visit with general practitioner? Your annual OBGYN appointment? Internal medicine provider?
If basic labs like a CBC and CMP were normal in the past year, and no changes have occurred in the headache pattern, then labs may not be required. Labs are typically normal in primary headache conditions. Some other labs to consider include B12, folate, and vitamin D3 levels. It is imperative that new onset headaches after age 50 include a ESR and CRP to rule out giant cell arteritis (temporal arteritis) which can cause blindness if it is not diagnosed.
How recent was your last eye exam? Do you have any visual disturbances? Before headaches, during headaches or not related to headaches. Do you experience floaters?
Floaters should be checked out by an ophthalmologist. Also, obese patients (BMI >30) or anyone with daily headaches that could be experiencing high pressure headaches, should be evaluated by an ophthalmologist to rule out papilledema or swelling of the optic nerve with can cause blindness if Idiopathic Intracranial Hypertension is not diagnosed and treated.
Do you have sleep apnea? Have you ever been tested with a sleep study? Do you snore? Do you have the risk factors?
Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. You may have sleep apnea if you snore loudly, and you feel tired even after a full night's sleep. Risk factors for sleep apnea include: male gender, overweight, age over 40, large neck size, large tonsils, tongue or small jaw bone, family history of sleep apnea, GE reflux, deviated septum, allergies or sinus problems.
Left untreated, sleep apnea can result in a growing number of health problems, including: high blood pressure, stroke, heart failure, irregular heart beats, and heart attacks, diabetes, depression, worsening of ADHD, and headaches. Patients that snore, or that are over 40 and obese or with other risk factors should be referred for a sleep study. Failure to diagnose sleep apnea and treat it with CPAP could result in further morbidity or death. Conversely, when properly treated, headaches often resolve on CPAP.